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Depression, Substance Abuse and Other Contextual Predictors of Adherence to Antiretroviral Therapy (ART) Among Haitians

AIDS and Behavior volume 17, pages 1221–1230 (2013)Cite this article

Abstract

Haiti has the highest number of individuals living with HIV in the Caribbean. Due to Haiti’s resource-poor environment and inadequate mental health and substance abuse services, adherence to antiretroviral therapy (ART) may be especially difficult. This study examined associations among demographics, maladaptive coping, partner conflict, alcohol problems, depression, and negative attitudes about medications and their impact on adherence among 194 HIV-positive Haitians. In a mediated directional structural equation model, depression and negative attitudes about ART directly predicted poorer adherence. Greater partner conflict, maladaptive coping and alcohol problems predicted more depression. Maladaptive coping predicted a negative attitude about ART. Alcohol problems predicted partner conflict and maladaptive coping. Significant indirect effects on adherence mediated through both depression and negative attitudes about ART include negative effects of female gender, alcohol problems and maladaptive coping. Results highlight the importance of integrated care for depression, alcohol use and other psychosocial problems to increase ART adherence.

Resumen

Haití tiene el número más alto de personas que viven con el VIH en el Caribe. Debido a la escases de recursos y servicios de salud mental y tratamiento del abuso de sustancias psicoactivas en el entorno Haitiano, la adherencia a la terapia antirretroviral (TARV) se puede volver especialmente difícil. Este estudio examinó asociaciones entre características demográficas, métodos inadaptados de lidiar, conflicto con la pareja, problemas relacionados al consumo del alcohol, la depresión, y las actitudes negativas sobre los medicamentos, y el impacto de dichas variables en la adherencia en 194 haitianos VIH-positivos. En un modelo de ecuación estructural, la depresión y las actitudes negativas sobre la TARV directamente predecían una adherencia inferior. Niveles más altos de conflicto con la pareja, métodos inadaptados de lidiar y problemas relacionados al consumo del alcohol predecían más depresión. Los métodos inadaptados de lidiar predecían una actitud negativa frente a la TARV. Problemas con el consumo del alcohol predecían conflicto con la pareja y métodos inadaptados de lidiar. Efectos indirectos significativos que afectan la adherencia mediados por ambas la depresión y las actitudes negativas sobre la TARV incluyen los efectos negativos del sexo femenino, problemas relacionados al consumo del alcohol y los métodos inadaptados de lidiar. Estos hallazgos recalcan la necesidad de una atención integral para la depresión, el consumo de alcohol y los problemas psicosociales para aumentar la adherencia a la TARV.

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Fig. 1

Notes

  1. Wherever a coefficient alpha was provided without citing another source, the statistic was calculated for this study sample. These coefficients reflected the Creole versions of instruments.

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Acknowledgments

This research was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism and a grant from the National Institute on Drug Abuse.

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Authors and Affiliations

  1. Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, 3000 N.E. 151 Street - ACI #260, Miami, FL, 33181, USA

    Robert Malow, Jessy G. Dévieux, Rhonda Rosenberg, Michele Jean-Gilles & Jennifer Attonito

  2. Department of Psychology, UCLA, Los Angeles, CA, USA

    Judith A. Stein

  3. Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Serena P. Koenig

  4. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

    Giuseppe Raviola

  5. Les Centres GHESKIO, Port-au-Prince, Haiti

    Patrice Sévère & Jean W. Pape

  6. Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, NY, USA

    Jean W. Pape

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  1. Robert Malow
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Malow, R., Dévieux, J.G., Stein, J.A. et al. Depression, Substance Abuse and Other Contextual Predictors of Adherence to Antiretroviral Therapy (ART) Among Haitians. AIDS Behav 17, 1221–1230 (2013). https://doi.org/10.1007/s10461-012-0400-1

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Keywords

  • Antiretroviral therapy
  • Haitians
  • Adherence
  • Depression